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Medication Adherence: The Cost of Missed Prescriptions

Prioritizing Medication Adherence Benefits Everyone

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80% of American adults enrolled in Medicare are prescribed at least one daily maintenance medication. With the vast majority of Medicare patients dependent on some type of prescription, and with 70% of the same population diagnosed with two or more chronic conditions, medication adherence is vitally important, now more than ever.

Last week, I had the pleasure of sitting down with Andrew Mellin, MD, Chief Medical Information Officer of Surescripts, to discuss the importance of medication literacy and adherence. We also discussed the innovative Lightbeam and Surescripts partnership and how it will drive medication compliance and education in our country’s most prescription-dependent population.

How Often Do Patients Really Take their Medications as Prescribed?

Based on recent data, medication non-adherence is present in:

  • 23% of Medicare patients with heart failure
  • 25% of Medicare patients with hypertension
  • 35% of Medicare patients with diabetes
  • 38% of Medicare patients with hyperlipidemia

These chronic illnesses depend on effective medication therapy to mitigate complications and prevent the condition from progressing. However, medication is only part of a multi-faceted solution and is complementary to other aspects of treatment, including a healthy diet and lifestyle modifications.

Patients with chronic conditions are also at higher risk of serious complications should their condition worsen, often resulting in an emergency department visit or lengthy hospital stay.

What Is the Cost of Non-Adherence?

Medication non-adherence leads to treatment escalation. This drives up the costs of care needed to manage a condition because additional resources are required to prevent the disease from progressing. Not only does this lead to a negative financial impact and poorer patient outcomes, but it can also result in treatment failure and lower quality of life. Financially, this translates to $100B – $289B in total avoidable Medicare spend each year.

However, when all is said and done, the ultimate cost of non-adherence is avoidable, premature death. Approximately 125,000 deaths are attributed to medication non-adherence annually.

Medication Adherence Education Benefits Everyone

It is estimated that up to 80% of medication non-adherence can be attributed to:

  • Uninformed decision-making, which can be caused by health illiteracy
  • Miscommunication or not setting clear expectations
  • Patient disengagement
  • Complexity of the regimen
  • Financial or cognitive constraints
  • Mismatched preferences

Sometimes, medication non-adherence is unintentional. While there are many people who forget about their medication or forgo taking prescriptions due to the complexity of the regimen or treatment disengagement, there are also individuals who may take prescriptions too often, too little, or at incorrect intervals. As previously mentioned, non-adherence leads to the domino effect of treatment escalation, disease progression, and—potentially—treatment failure.

If one out of every four nonadherent Medicare FFS beneficiaries with hypertension became adherent to medication therapy, Medicare could save $13.7B per year. This would be a tremendous asset to the longevity of Medicare, as well as the lives of the patients with prescription-dependent chronic illnesses.

How Is Data Used to Drive Medication Adherence?

Leveraging technology to achieve improved medication adherence and condition literacy can change the lives of thousands, if not millions, as well as dramatically impact the solvency of Medicare. Through Lightbeam’s and Surescripts’ partnership, we use data as an insight into patient behaviors and needs. Notifications are sent for high priority or controlled medications, such as when a new medication is prescribed or allowable refills are exhausted. A notification is also sent if the prescription is not picked up, signaling a patient is at risk for non-compliance with their treatment plan.

Transforming insights into action, care managers can tailor clinical interventions to engage patients and improve outcomes. As we reduce the costs associated with avoidable Medicare spend, we also enhance and lengthen the lives of patients impacted by medication non-adherence.

To hear more about the importance of medication adherence, be sure to watch my webinar co-hosted by Dr. Andrew Mellin.




By Shelley Davis, MSN, RNC, CCM
VP of Clinical Strategy

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